Provider Demographics
NPI:1235124579
Name:HEBREW HOME OF GREATER WASHINGTON INC
Entity Type:Organization
Organization Name:HEBREW HOME OF GREATER WASHINGTON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:301-770-8433
Mailing Address - Street 1:6121 MONTROSE ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4803
Mailing Address - Country:US
Mailing Address - Phone:301-770-8366
Mailing Address - Fax:301-770-8512
Practice Address - Street 1:6121 MONTROSE ROAD
Practice Address - Street 2:ATTN. FINANCE AND ACCOUTING DEPARTMENT
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4803
Practice Address - Country:US
Practice Address - Phone:301-770-8366
Practice Address - Fax:301-816-7747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15-015314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD155557000Medicaid
MD215071Medicare ID - Type Unspecified